Provider Demographics
NPI:1043621030
Name:BIRDWELL, ANGELA LAUREN (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LAUREN
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12446 WEST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2530
Mailing Address - Country:US
Mailing Address - Phone:210-656-3600
Mailing Address - Fax:
Practice Address - Street 1:12446 WEST AVE STE 2001244
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2517
Practice Address - Country:US
Practice Address - Phone:210-656-3600
Practice Address - Fax:210-656-3603
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050795207R00000X
TXS5325207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS5325OtherTEXAS MEDICAL BOARD
TX582864OtherPHYSICIAN IN TRAINING LICENSE